11D2025057 CLIA NUMBER - SOUTHEASTERN DERMATOPATHOLOGY, LLC

Laboratory Demographics

  • CLIA Code: 11D2025057
  • Facility Name: SOUTHEASTERN DERMATOPATHOLOGY, LLC
  • Facility Address: 1067 WINDERMERE XING
    CUMMING, GA
    ZIP 30041
  • Facility Phone: 205 910-6852
  • Facility Type: Independent
  • Facility Type: Certificate of Compliance
  • Lab Director: MOLLY B. BOULDIN
  • NPI Number: 1932497492
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 11D2025057
LAB Type Independent
Facility Name SOUTHEASTERN DERMATOPATHOLOGY, LLC
Street 1067 WINDERMERE XING
City CUMMING
State GA
ZIP 30041
Phone 205 910-6852
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 9/29/2023
Certificate Expiration Date 10/31/2025
Facility Type Independent
Lab Director MOLLY B. BOULDIN

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This page was last updated on: 9/29/2025